@2024 Afarand., IRAN

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ISSN: 2383-2150    Journal of Education and Community Health 2020;7(4):229-237

Background
Cancers are the second leading cause of death globally with approximately 14 million new cases per year [1]. Gastric cancer is the most common gastrointestinal cancer [2].
Previous Studies
…[3]. According to the Cancer Institute and Disease Control Center of the Ministry of Health and Medical Education, gastric cancer is the first and third most common cancer in men and women, respectively [4]. The incidence of gastric cancer in Iran has increased in men and women [5] and the study of different cancers in Iran shows that in women, gastric cancer has the highest incidence after breast cancer. It is estimated that by 2025, the risk of gastric cancer will increase by 38% [6]. This cancer occurs in women in the lower age group [7]. …[8-11]. Increasing the effectiveness of health education depends on the proper use of theories and models. One of them is the Health Belief Model. This model is a preventive model that considers behavior as a function of individual knowledge and attitude and includes the constructs of perceived sensitivity, perceived intensity, perceived benefits, perceived obstacles, and perceived self-efficacy, and guidelines for practice [12]. The Health Belief Model emphasizes that, as a general rule, people respond well to health messages and disease prevention when they feel they are in danger (perceived threat). Consequently, they also understand the benefits of changing their behaviors (perceived benefits). Therefore, they easily remove the obstacles to these changes (perceived obstacles) and believe that they have the ability to perform nutritional behaviors (perceived self-efficacy). Under these circumstances, training interventions and programs are likely to be effective [13].
Aim(s)
The aim of this study was to determine the effect of training intervention on nutritional behaviors related to gastric cancer in working women in Fasa city, using the Health Belief Model (Fars province).
Research type
This study is a quasi-experimental study.
Research society, place and time
This study was carried out on 100 married women working in Fasa city in 2017-2018.
Sampling method and number
Two centers (one as a test and the other as a control) were randomly selected from 6 Urban Health Centers of Fasa city. Sampling in each center was conducted randomly considering the information registered in the Sib system of the mentioned centers and according to the inclusion criteria among working women referring to the selected health centers. Inclusion criteria include working women with at least 20 years old, married, no history of gastric cancer in the subjects and their family members. Exclusion criteria also include the retirement of working women, and unwillingness to cooperate and be absent for more than two training sessions. The sample size was 72 subjects as well as, 100 people were selected to increase the power in each group considering the previous study [14] and taking into account the maximum error of the first type of 0.05 and the study power of 90%, the standard deviation of 5.38 before the intervention, and 5.76 after the intervention, and the mean difference of 3.72.
Used devices&materials
The data collection tool was a questionnaire based on the Health Belief Model, which was designed according to various studies [4, 14]. ... [15, 16]. The training intervention for the test group was performed directly using lecture methods, group discussion through questions and answers, brainstorming, practical show, video screening, and the use of educational images. The training sessions for the test group included 8 sessions of 50 to 55 minutes in the Health Center (two sessions per week). At the end of the sessions, an educational and motivational text message was sent to the subjects every week. Follow-up sessions were held to review the content and performance of individuals, monthly. After the study, in order to observe ethical considerations, a training session was held for the control group and the training booklet was provided to them. The number of training sessions increased due to the absence of some working women to attend training sessions due to administrative missions. Therefore, the researchers held a training session twice a day. After the completion of the research project, a training session was held in the hall of the Health Center through an emphasis on the structures of the Health Belief Model along with the presentation of an educational booklet for the subjects in the control group.Data were analyzed using SPSS 22. Repeated measures ANOVA test was used to compare the mean scores of the variables. Independent t-test was used to compare the average age of the subjects, and mean scores in the two groups. Chi-square test was used to compare the jobs and education levels of the subjects and their husbands, their family history of cancer, and history of diet training.
Findings by Text
The average age of the subjects was 35.64±5.30 in the test group and 35.70±5.38 in the control group, which based on the independent t-test, no significant difference was observed between the test and control groups (p=0.423). The difference of the other demographic characteristics of the subjects were not significant in the two groups (Table 2).The results showed that there was no significant difference between the test and control groups in terms of knowledge, perceived sensitivity, perceived intensity, perceived benefits, perceived self-efficacy, and performance before the training intervention. However, a significant increase was observed in the test group in each of the mentioned factors, except for the perceived obstacles, in 3 and 6 months after the intervention. In the structure of perceived obstacles, the test group had a significant decrease compared to the control group (Table 3).
Main comparison to the similar studies
The results of Dehdari et al. [11], Lane et al. [17], Anderson et al. [18], Kasiri et al. [14], Alidousti et al. [19], and Shobeiri et al. [20] are in accordance with the findings of this study. Ziaei et al. [21] and Alizadeh et al. [22] also reported an increase in the mean of perceived sensitivity after the training intervention, which is consistent with the results of the present study. ... [23, 24]. Findings of Alidousti et al. [19], Kasiri et al. [14] and Shobeiri et al. [20], Lotfi et al. [25] and Khiali et al. [26] showed that training intervention increased the perceived severity score which is in accordance with the results of this study; but in the study of Dehdari et al. [27], Park et al. [28] and Iryama et al. [29] the perceived intensity did not change after the training intervention. The results of the studies of Gimnogarcia et al. [30], Khani et al. [31], Ochi and Gozum [32], and other studies [27, 33] are consistent with the results of this study. Awareness promotion and correcting misconceptions with discussion can play the effective role in reducing perceived obstacles. Training intervention in the studies of Alidousti et al. [19], Dehdari et al. [27], and Lotfi et al. [25] led to the reduction of perceived obstacles in the test group, which is in accordance with the results of the present study. In this study, the mean score of the perceived self-efficacy also increased at 3 and 6 months after the training intervention in the test group, but no significant change was seen in the control group. The results of the studies of Alidousti et al. [4], Kasiri et al. [14] and Dehdari et al. [27], and Khastehivari et al. [33] are consistent with the results of this study. ... [34-38]. The results of studies by Anderson et al. [39] in Scotland, and Bohr et al. [40] in the United Kingdom showed that no improvement in the nutritional behaviors of pregnant women was observed, despite providing the necessary knowledge to them. Lack of significantly positive effect of nutrition training can be related to the factors such as lifestyle [41], beliefs of society [39], economic issues [42], and access to food [40, 42].
Suggestions
Design and implementation of training interventions in the field of gastric cancer prevention with a focus on nutritional performance is effective on working women based on the Health Belief Model. It is also recommended to study on vulnerable groups such as single men and women and students.
Limitations
One of the limitations of this study was the collection of nutritional information using a self-report questionnaire.
Conclusions
Design and implementation of training interventions is effective on working women based on the Health Belief Model in the field of gastric cancer prevention with a focus on nutritional performance.
Acknowledgments
This study was carried out with the financial support of the Research Assistant of Fasa UniversThis article is retrieved from the research project approved by Fasa University of Medical Sciences with project number of 97085, under the financial support of the Research assistant of Fasa University of Medical Sciences.ity of Medical Sciences.
Conflict of interest
There is no conflict of interest.
Ethical Permissions
This study was approved by the Ethics Committee in the Research Assistant of Fasa Medical Sciences university (Ethics Code: IR.FUMS.REC.1397.079).
Funding Sources

TABLES and CHARTS

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